Provider Demographics
NPI:1194764423
Name:NEHRA, ARVIND (MD)
Entity type:Individual
Prefix:
First Name:ARVIND
Middle Name:
Last Name:NEHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11475 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7128
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-569-1787
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-6031
Practice Address - Fax:314-251-6343
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350930532085R0204X, 2085R0202X
MO20160342032085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2925446Medicaid
OH2925446Medicaid
MO107690025Medicare PIN
OHH382830Medicare PIN
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
MN712653100Medicaid
MN171883OtherUCARE
WI34440200Medicaid
MN1602575OtherMEDICA
IA0575225Medicaid
MN1035435OtherPREFERRED ONE
MN300G3NEOtherBLUE CROSS
MNHP44294OtherHEALTHPARTNERS